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Prescription Benefit Summaries: HMO/POS/DPOS — Groups 51+IBC Forms Online
The Prescription Benefit Summaries: HMO/POS/DPOS section provides a comprehensive list of Independence Blue Cross prescription benefit summaries for you to access. Select the desired plan to view the available benefits summaries.
Forms are in pdf format.
| Option | Last Updated |
|---|---|
| $ 0 | 2010-01 |
| $10/$15 | 2010-01 |
| $10/$20 | 2010-01 |
| $10 | 2010-01 |
| $1/$3 | 2010-01 |
| $15 | 2010-01 |
| $ 1 | 2010-01 |
| $2/$6 | 2010-01 |
| $3/$5 | 2010-01 |
| $4/$8 | 2010-01 |
| $ 4 Generic/Brand Discount HMO Standard Drug | 2010-04 |
| 50% | 2010-01 |
| $5/$20 | 2010-01 |
| $ 5 | 2010-01 |
| $6/$10 | 2010-01 |
| $7/50%/$125 Max HMO Standard Drug | 2010-04 |
| $7 Generic/50% with $250 Max Brand HMO Standard Drug | 2010-05 |
| $ 7 Generic Only/Brand Discount HMO Standard Drug | 2010-05 |
| $8/$14 | 2010-01 |
